Holt: Primary Care, Especially for Elderly, Will Be Improved by Health Care Reform

Ellen Gilbert

I cant help but talk about it as a historic piece of legislation, said Congressman Rush Holt (D-12) in a recent conversation with district AARP members, which also included call-in questions from telephone listeners.

Social Security was passed by Congress in 1935, Mr. Holt observed. Until that time to be old was to be destitute. The average income was below the poverty line. Social Security changed the nature of what it was to be American. It encouraged entrepreneurship at younger ages, because you didnt have to live in fear of being in poverty. Medicare followed.

Mr. Holt sees the new health care legislation as carrying on in that tradition. He reported that he was pleased to have been invited by President Obama to be present at the signing of the bill.

AARP has been constructive this year when theres been a lot of misinformation about what is being attempted, and it has done more than just about anybody I can think of to clarify what is intended by the reform legislation and how it will actually affect you and hundreds of millions of Americans, said Mr. Holt, thanking the association for its public education efforts.

Mr. Holt cited improvements to Medicare and the expectation of health care coverage for everyone in America as positive outcomes of the new legislation. All of this would be a hollow victory if we didnt improve the quality of care we currently give under the system, he observed. Other pluses include incentives for medical and nursing students to become primary care providers, with an emphasis on starting points of treatment.

If the new health care bill is good for seniors, how come my health insurance premiums and other fees have gone up? asked an audience member as the discussion moved into the question and answer segment.

Health care costs were getting out of control, Mr. Holt responded. Medicare has been better than other programs in keeping down the rate of growth. But with inflation of medical costs increasing six, eight, and ten percent a year, no insurance company could sustain that. This legislation will do a lot to hold down the increase in costs, which rose because of inefficiencies in the system, and because insurance companies are profit-driven.

You would think that most of the premiums you pay into insurance companies would go for treatment, he added. In fact, only about 75 percent goes into real health care. This will change that.

Asked how these new laws will make Medicare better, Mr. Holt noted that Medicare is already a good to excellent program. The idea is to keep it working, and, in some ways, improve it. Critics usually say Medicare cant be working because they hear its going broke. The point is, no insurance company can stay in business if we have the kind of inflation weve been having. This legislation will help provide better primary care. With more primary care physicians and nurses there will be no need to shop around for a specialist. Someone will know you as a patient, not just as a procedure. Primary care physicians see you as a whole person. It actually will save the system money, because you wont be sent for test after test, and someone will make sure tests arent repeated.

There will be a real crackdown on waste and fraud and inefficiency, he commented, noting the fake clinics, doctors, and gadgets, especially in Florida, that try to cash in on Medicare.

Asked about oversight of waste, fraud, and abuse in Medicare, Mr. Holt suggested hiring more auditors and investigators, improved reporting, and increased transparency, so users will be better able to recognize something fishy.

Mr. Holt cited statistics indicating that 50 percent of elderly patients are re-hospitalized, usually within 30 days of a previous hospitalization. In many cases, he noted, this was because the hospital failed to do appropriate follow-up, with nurses and social workers making sure that patients were taking their medications and following physical therapy regimens. The new legislation, he said, might keep the patient in the hospital for an extra day to ensure improved follow-up, but would result in fewer re-hospitalizations.

There will be no co-pays or expenses for preventive medicine, including mammograms, prostate screening, colonoscopies, and annual wellness visits, added Mr. Holt. And, there will be lower drug costs. When you fall of the cliff  when you get to $2800  which is not hard to do with todays prescription costs  and suddenly you dont get help  Medicare will now pay you $250 to help with prescriptions. In subsequent years, this cliff will be filled in.

Mr. Holt reported that the new legislation will extend the solvency of Medicare by about a decade, relieving some of the pressure. He acknowledged that its not enough, however, and that Congress and Medicare are going to have work on it.

The AARP website, www.aarp.org/, includes a link to a special section on what you need to know now about the new landscape of health insurance.